The goal of this postdoctoral fellowship will be to facilitate the candidate's development as a leader in health services research focused on healthcare disparities in the quality of care delivered to minority populations. Building on her background in obstetric anesthesiology and public health, the candidate proposes to develop additional skills during the award period through 1) coursework designed to expand her methodological skills;2) interaction with a multidisciplinary team of sponsors and collaborators, including those in health services research (Dr. Romana Hasnain-Wynia), obstetrics (Dr. William Grobman), and anesthesiology (Dr. Cynthia Wong);and 3) a series of supervised research projects. The overall objective of these projects is to identify patient and provider factors that can be targeted for interventions at reducing disparities in labor analgesia utilization. This will be accomplished through three specific aims: (1) to assess the effect of race/ethnicity on labor and delivery providers'(anesthesiologist, obstetrician, nursing) analgesic recommendations using clinical vignettes, (2) to evaluate labor and delivery providers'(anesthesiologist, obstetrician, nursing) attitudes, beliefs, and practices regarding labor analgesia in patients of differing races/ethnicities through semi-structured interviews, and (3) to identify key patient factors associated with the decision to utilize epidural labor analgesia through semi-structured interviews. These projects, in conjunction with the chosen coursework and mentorship interactions, will allow the candidate to become proficient in qualitative and statistical methodology. Towards the end of the award period, the candidate plans to develop a career development award that will propose to: 1) design an educational intervention for patients to help educate them about labor analgesic options, its risks, and benefits;and 2) develop an educational tool for labor and delivery providers to help educate them about providing equitable care to women from diverse racial/ethnic/cultural backgrounds regarding their options for labor analgesia. This project will meet the mission of the Agency for Healthcare Quality and Research by helping to improve the quality of healthcare for all Americans by ensuring that the care we are delivering is equitable. PUBLIC HEALTH RELEVANCE: Racial and ethnic disparities resulting in inadequate treatment of pain in minority populations are a significant public health problem and a quality of care issue. This project will benefit public health by identifying both the patient and physician factors underlying the disparity in labor analgesia usage. The results of this study will be used to design interventions for both patients and physicians aimed at decreasing this disparity and improving the quality of care delivered during labor to Hispanic and African American populations.